Newcomer R, Spitalny M, Fox P, Yordi C
Dept. of Social and Behavioral Sciences, University of California, San Francisco 94143-0612, USA.
Health Serv Res. 1999 Aug;34(3):645-67.
Did the Medicare Alzheimer's Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers?
Baseline and periodic caregiver interviews. Measures include client and caregiver attributes and self-reported service use.
The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. The actual monthly entitlement varied among the eight demonstration communities due to regional cost and inflation adjustments over time. Analyses are for the year after enrollment.
Analyses are of cases surviving six months or more in the community after enrollment (n = 5,209). Cases received baseline and semi-annual assessments.
The intervention of case management and community service reimbursement had a strong, consistent, and positive effect on the likelihood of using home care (including homemaker/chore services, personal care services, companion services) and adult day care. Treatment group clients were at least twice as likely as control group clients to be using any of the four community-based services. A similar, but less pervasive effect was achieved with caregiver training and support group participation. Reimbursement provided by the demonstration's Medicare waiver was generally not sufficient to exceed the level of control group service acquired through private payment.
Reimbursement levels within the demonstration may have enabled more individuals to purchase some services, but they were not sufficient to increase the average level of use over those in the control group. No consistent differences between demonstration models were found in service use likelihood or average use among users.
医疗保险阿尔茨海默病示范项目及其病例管理和社区服务豁免是否影响了痴呆症患者及其主要照料者对社区长期护理服务的使用？
基线和定期照料者访谈。测量指标包括客户和照料者的特征以及自我报告的服务使用情况。
该示范项目将自愿申请者随机分为治疗组和对照组。治疗组病例有资格接受病例管理，并每月获得高达699美元的社区护理福利。由于区域成本和随时间的通胀调整，八个示范社区的实际每月补贴有所不同。分析针对入组后的一年。
分析对象为入组后在社区存活六个月或更长时间的病例（n = 5209）。病例接受了基线和半年一次的评估。
病例管理和社区服务报销干预对使用家庭护理（包括家务/杂务服务、个人护理服务、陪伴服务）和成人日托的可能性产生了强烈、一致且积极的影响。治疗组客户使用四种基于社区服务中任何一种的可能性至少是对照组客户的两倍。照料者培训和支持小组参与也产生了类似但不太普遍的效果。示范项目的医疗保险豁免提供的报销通常不足以超过通过私人支付获得的对照组服务水平。
示范项目中的报销水平可能使更多人能够购买一些服务，但不足以提高使用水平超过对照组。在服务使用可能性或使用者的平均使用量方面，未发现示范模式之间存在一致差异。
